Method For Delivering Subjective Surveys Linked to Subjective and Objective Data

ABSTRACT

A patient interaction apparatus  10  includes a medical server  13  that generates a reflexive survey as a result of items of interest (such as abnormal or unexpected vital signs) in objective or subjective data reported from a patient interface device  11 . The survey of the present invention reacts to objective results with the intent of probing into the patient&#39;s current condition. The patient survey of the present invention specifically probes why a patient&#39;s weight, blood pressure, or pulse rate, to name only a few examples, may be higher than expected. Various methods for determining the trigger conditions and the elimination of erroneously reported vital signs are set forth. The patient&#39;s objective or subjective data includes one or more of the following: blood pressure, pulse rate, temperature, weight, electrocardiogram, electroencephalogram, brain wave, breathing pattern, biochemical measurements, serum glucose, blood gasses, physiologic data, non-physiologic data, exercise or activity measures, presence or absence measures, or any function of objective or subjective data measurable or deducible regarding the patient.

The present invention relates generally to methods and apparatuses forinterviewing patients, and more particularly to a method and apparatusfor interviewing a patient using a survey.

Patients often complete generic surveys regarding their health. Forexample, U.S. Pat. No. 6,168,563 discloses a system and method thatenables a health care provider to monitor and manage a health conditionof a patient. The system includes a health care provider apparatusoperated by a health care provider and a remotely programmable patientapparatus that is operated by a patient. The health care providerdevelops a script program using the health care provider apparatus andthen sends the script program to a remotely programmable patientapparatus through a communications network, such as the World Wide Web.The script program is a computer-executable patient protocol thatprovides information to the patient about the patient's health conditionand that interactively monitors the patient health condition by askingthe patient questions and by receiving answers to those questions. Theanswers to these health related questions are then forwarded as patientdata from the remotely programmable patient apparatus to the health careprovider apparatus through the communications network. The patient datamay also include information supplied by a physiological monitoringdevice, such as a blood glucose monitor that is connected to theremotely programmable patient apparatus. When the patient data arrivesat the health care provider apparatus, the patient data is processed forfurther management of the patient's health condition by the health careprovider, such as forwarding another script program to the remotelyprogrammable patient apparatus.

In addition, U.S. Pat. No. 4,803,625 discloses a personal health monitorthat includes sensors for measuring patient weight, temperature, bloodpressure, and ECG waveform. The monitor is coupled to a central unit viamodems and includes a computer which is programmed to prompt a patientto take prescribed medication at prescribed times, to use the sensors tomeasure prescribed health parameters, and to supply answers to selectedquestions. Medication compliance information, test results, and patientanswers are compiled in a composite log, which is automaticallytransmitted to the central unit. The computer is also programmedautomatically to disconnect the monitor from an alternating currentpower source and to rely on internal battery power during certainperiods of patient-monitor interaction, such as during use of the ECGmodule. In this way, danger to the patient and complexity of the ECGmodule are minimized. The computer is also programmed to comparemeasured test information with predetermined expected values, and in theevent of a discrepancy, to collect additional information from thepatient to assist trained personnel at the central unit in interpretingthe composite log. The computer is also programmed to alert the centralunit promptly in the event one or more measured parameters falls outsideof a prescribed normal range. The normal range for a given parameter ismade to vary in accordance with the measured value of one or more otherparameters in order to reduce the incidence of false alarms.

The surveys employed in the above systems are selected for the patientin advance, without knowledge regarding the patient's daily or currentvital signs. Often; patients would receive whatever survey wasscheduled, sometimes weeks in advance without any knowledge of apatient's medical signs.

The present invention is therefore directed to the problem of developinga method for obtaining information that is specifically tailored to apatient's current medical condition.

The present invention solves these and other problems by providing asurvey that is generated as a result of a variety of data obtainablefrom the patient, such as abnormal or unexpected vital signs, whichcould constitute objective data or subjective data. Examples couldinclude objective data, such as a vital sign that lies outside a normalrange, or subjective data, such as a response to “how are you feeling”or even results from a prior survey. For example, a basic survey ‘A’could be sent to the patient to broadly assess their condition. Oncereturned to the ‘back end’, this survey could be ‘scored’ using somealgorithm, and some logic run against that score might trigger anothersurvey. Concretely, a daily survey might ask high-level questions abouthow the patient is doing. Some algorithm run on the responses to thissurvey could generate a score that indicated that the patient might beat risk for depression. In response, the back-end could automaticallysend a survey focused on determining depression status, to confirm andprovide additional detail on the original indication. Thus, the surveyof the present invention reacts to subjective results with the intent ofprobing into the patient's current condition. As opposed to the priorart, in which patients might receive a preset survey despite the factthat the patient's vital signs were markedly abnormal at the time thepatient survey was being completed, the patient survey of the presentinvention specifically probes why a patient's weight, blood pressure, orpulse rate, to name only a few examples, may be higher than expected.

According to other aspects of the present invention, various methods fordetermining the trigger conditions and the elimination of erroneouslyreported vital signs are set forth.

According to one exemplary embodiment of a method for triggering asurvey a patient's abnormal condition is determined by comparing thelatest reported measurement against a preset threshold, a previouslyrecorded value or both. The comparison criteria can be an absolute value(high or low threshold), or relative variances (e.g., five percent inthe last seven days, three pounds within twenty-four hours, etc.).

According to another aspect of the present invention, a filter isemployed to eliminate the use of erroneous measurements that falloutside of the reasonable range (e.g., a doubling of weight in one day).

In addition, the present invention gives the reflexive survey a higherpriority in delivering and presentation than that of a scheduled survey.A generated reflexive survey would reach the patient before a regularlyscheduled survey. A generated reflexive survey would also expire after aspecific period, as the condition of the patient may change and newmeasurements are presumably taken over time.

These and other advantages will be apparent upon review of the detaileddescription in light of the following drawings.

FIG. 1 illustrates an exemplary embodiment of an apparatus for obtainingmedical information from a patient according to one aspect of thepresent invention.

FIG. 2 depicts an exemplary embodiment of a method for obtaining medicalinformation from a patient according to another aspect of the presentinvention.

It is worthy to note that any reference herein to “one embodiment” or“an embodiment” means that a particular feature, structure, orcharacteristic described in connection with the embodiment is includedin at least one embodiment of the invention. The appearances of thephrase “in one embodiment” in various places in the specification arenot necessarily all referring to the same embodiment.

Turning to FIG. 1, in an exemplary embodiment 10 of a system oftelemedicine vital signs are reported from a patient's home using aPatient Interactive Survey Device 11 a-c to a monitoring server 13. Theserver 13 generates unique surveys for the patient based on reportedvital sign values from the patient and pre-configured thresholds. Theserver may also generate surveys based on objective or subjective data,such as how one feels, abnormal vital signs, clinically significantdata, or even a prior completed (or not completed in time) survey.

The Patient Interactive Survey Device 11 can be a personal computer,laptop, handheld computer, Palm Pad, automated voice response system orother device configured to receive data, display the data and to acceptinput from a patient.

Another possible embodiment of the Patient Interactive Survey Device 11might involve several devices to accomplish the input/output tasksherein. For example, instead of an integrated device, such as a laptopor a computer, the Patient Interactive Survey Device might comprise acombination of: (1) code executing in a processor in a set-top box, (2)a TV, and (3) a remote control. Other possibilities are alsopossible—perhaps using the combination of a cell phone and a TV. ThePatient Interactive Survey Device 11 receives reflexive surveys. As usedherein, the term “reflexive” survey means any survey that is generatedin response (e.g., reflexively) to some subjective or objective trigger.For reference, the other survey types we define are (a) “scheduled”, forthose that are calendar-driven, and (b) “one-time”, for a survey that isspecified explicitly by a physician or care provider. The PatientInteractive Survey Device 11 also enables the patient to input answersto the survey and store them for later forwarding to the medical server13.

Alternatively, the Patient Interactive Survey Device 11 can be that asdisclosed in U.S. Pat. No. 6,168,563, which is hereby incorporated byreference as if repeated herein in its entirety, including the drawings.

Moreover the Patient Interactive Survey Device 11 can include parts ofthe system disclosed in U.S. Pat. No. 4,803,625, which is herebyincorporated by reference as if repeated herein in its entirety,including the drawings.

The preconfigured thresholds used by the server 13 can be of absolutevalue or a percentage of change from a previous value. In general, thesethresholds could pertain to any arbitrary algorithm. Also, the thresholdcould apply to a ‘score’ of some other subjective data (such as answersto a previous survey). The server 13 then delivers the reflexive surveyto the patient's home device 11 a-c to probe into the patient'scondition. A home device 11 a-c (which may be the same as the one thatreported the vital sign values) receives the survey and presents thesurvey to the patient for interaction.

A reflexive survey consists of a list of questions and their possibleanswers from which the patient can select, and path information tonavigate the question list. The questions could be structured into atree (specifically, a ‘directed acyclic graph’ structure), of which anordered list is a simple case. The survey can be predefined, ordynamically compiled at the server from available questions. Once thepatient has answered the survey, the results are reported to the server13. The system 10 correlates and makes available both the objectivevital signs and the subjective answers for the system user to review.The system may also present a ‘summary’ or ‘score’ view of thesubjective answers, to aid quick review of the survey results.

FIG. 1 also shows a measurement device 14, which could be a scale tomeasure weight, a blood-pressure cuff. This device 14 could be astandalone device, as in the case of a scale or an implanted device,e.g., pacemaker, implantable cardiac defibrillator, and implantedinfusion pump. The data from measurement device 14 could be coupled tothe Patient Interactive Survey Device 11 (hence the link from themeasurement device to the PISD 14) or the data could be coupled directlyto the server 13 (hence the other link from the measurement device tothe server). Of course, the patient could obtain this data and enter itinto the PISD 14 himself.

Turning to FIG. 2, shown therein is an exemplary embodiment of a methodfor obtaining patient information according to another aspect of thepresent invention. This method generates a survey in response toreceived data from the patient, either objective or subjective data (oreven a prior survey), which data includes an “item of interest.” Thisitem of interest varies from application or patient, however, it coversany aspect of the patient that one might deem interesting, including anyabnormal or medically significant data, patient diagnosis information,patient mental or physical state, or even data that might indicate someimprovement in one's personal health or well-being.

In element 21, objective and/or subjective data from a patient ismonitored, such as a patient's vital measurements. The system may allowfor ‘a-periodic’ monitoring in which samples are not obtained on anyfixed or defined time base, but rather, the measurements are obtainedwhenever they're available. These measurements can include one or moreof the following: blood pressure, pulse rate, temperature, weight,electrocardiogram, electroencephalogram, brain wave, breathing pattern,biochemical measurement, etc. The patient can either report these to apatient interface device or the device itself can be recording them. Thedevice may be a free-standing unit, such as a scale or a glucose meter,which the subject places where convenient. Alternatively, this devicecould be a monitoring unit that is implanted in the patient, such as asensor on a pacemaker, and implantable cardioverter defibrillator, or animplanted infusion pump. The ‘data’ may also be of the ‘subjective’variety, such as how does one feel, or other data that can be used toprobe a patient's mental or physical health.

In element 22, the patient's data is forwarded or transmitted to acentral server from the patient interface device. This can beaccomplished via the Internet or any other communications link capableof sending data or files. This element can be a store and forwardtransfer type communication or simply a real-time communication.

In element 23, the patient's data is received at a central server, alongwith other patients' data from other patient interface devices. Multiplepatients can be monitored in this manner.

In element 24, the received vital measurements are filtered to removepotentially erroneous measurements. This filtering is conducted on allreceived data.

In element 25, if existing, an item of interest (such as an abnormalmeasurement or vital sip) is identified. The item of interest need notbe ‘abnormal’ or even clinically significant—just “of interest.” Forexample, the system could send a congratulatory message to someone whohad kept his weight under control for the past few weeks.

In element 26, a reflexive survey is generated based on one or moretriggering events, such as an identified item of interest, for eachpatient that has one or more triggering events, by matching a previouslycreated reflexive survey to a received triggering event, such as anidentified item of interest. This is accomplished by, for example,matching a received abnormal response to a predetermined reflexivesurvey. For example, a patient having an abnormal heart rate would besent a survey designed to query the patient about his heart or otherconditions that might affect the heart. Thus, the exemplary embodimentinitiates a reflexive survey as a result of abnormal results of somevital measurements received. Thus, the exemplary embodiment customizeson a dynamic basis (or using previously developed questions) questionsand answers according to the trigger measurement. The exemplaryembodiment determines the trigger conditions of the patient's vitalsigns. The exemplary embodiment filters the vital signs to eliminateerroneous measurements.

In element 27, the reflexive survey is forwarded to each patient havingan identified item of interest. This is accomplished using the Internetor any communications link capable of transmitting data or files. Forexample, the generated survey could remain on the server to beretrieved/presented to the patient whenever “appropriate”. For example,in the TV/set-top box scenario, the survey could remain at the ‘backend’ until the patient started using the interactive TV application toreview his/her surveys.

In element 28, the reflexive survey is presented to the patient via bythe patient's interface device.

In element 29, the patient interacts with the reflexive survey via thepatient's interface device. This includes displaying the reflexivesurvey to the patient and obtaining answers to the questions included inthe reflexive survey.

In element 31, the completed reflexive survey is forwarded to thecentral server via the patient's interface device.

In element 32, the central server receives the completed reflexivesurvey. The results of the survey or just a score or alert summarizingthese results may be presented to the clinical user. In addition, one ormore surveys may then be generated based on the received completedreflexive survey. In fact, a patient may then interact with the centralserver via one or more additional surveys depending upon the responsesin each completed survey. Note that a scored subjective survey couldtrigger another subjective survey.

Although various embodiments are specifically illustrated and describedherein, it will be appreciated that modifications and variations of theinvention are covered by the above teachings and are within the purviewof the appended claims without departing from the spirit and intendedscope of the invention. For example, certain vital measurements arediscussed, however, any physical measurement can be employed withoutdeparting from the scope of the present invention. Furthermore, thisexample should not be interpreted to limit the modifications andvariations of the invention covered by the claims, but is merelyillustrative of one possible variation.

1. A method for obtaining health information from a patient comprising:generating a survey in response to one or more triggering events; andpresenting the generated survey to the patient.
 2. The method accordingto claim 1, wherein said one or more triggering events comprisesreceiving one or more abnormal or unexpected vital signs that exceed athreshold.
 3. The method according to claim 1, wherein said one or moretriggering events comprises receipt of objective data that matches acriterion.
 4. The method according to claim 1, wherein said one or moretriggering events comprises receipt of subjective data that matches acriterion.
 5. The method according to claim 4, wherein said one or moretriggering events comprises receipt of a completed survey.
 6. The methodaccording to claim 2, wherein said preset threshold is based on one ormore prior vital signals received from the patient.
 7. The methodaccording to claim 6, wherein said threshold is determined by anyarbitrary function of subjective and/or objective data.
 8. The methodaccording to claim 6, wherein said threshold is calculated as a functionof data from other patients.
 9. The method according to claim 1, furthercomprising: filtering received vital signs to eliminate erroneousmeasurements.
 10. The method according to claim 1, further comprising:attaching an expiration date to the survey so that the survey expiresafter the attached expiration date.
 11. A method for obtaining patientinformation comprising: monitoring subjective or objective data from apatient; and generating a reflexive survey based on received data thatincludes an item of interest.
 12. The method according to claim 11,further comprising: matching each received item of interest to apreviously created reflexive survey.
 13. The method according to claim12, further comprising: presenting at least one of the matchedpredetermined reflexive surveys to each patient having the item ofinterest.
 14. The method according to claim 12, further comprising:interacting by each patient with the matched reflexive survey via thepatient's interface device.
 15. The method according to claim 11,further comprising: receiving the patient objective or subjective dataat a central server, along with one or more other patients' objective orsubjective data from one or more other patient interface devices. 16.The method according to claim 8, further comprising: identifying one ormore items of interest, if any, among the received patients' objectiveor subjective data.
 17. The method according to claim 16, wherein anitem of interest includes an abnormal measurement.
 18. The methodaccording to claim 17, further comprising: receiving by the centralserver a completed reflexive survey; and generating one or more surveysbased on the received completed reflexive survey.
 19. The methodaccording to claim 8, wherein said patient's objective or subjectivedata includes one or more of the following: blood pressure, pulse rate,temperature, weight, electrocardiogram, electroencephalogram, brainwave, breathing pattern, biochemical measurements, serum glucose, bloodgasses, physiologic data, non-physiologic data, exercise or activitymeasures, presence or absence measures, or any function of objective orsubjective data measurable or deducible regarding the patient.
 20. Anapparatus for obtaining health information from a patient comprising: apatient interactive device to receive objective or subjective data froma patient and to couple to a network to transmit the objective orsubjective data and to receive a patient survey; and a medical server tocouple to the network for generating a medical survey in response toreceipt of one or more items of interest in the objective or subjectivedata from the patient interactive device and to transmit the medicalsurvey to the patient.